Prohibition of Abortion in Chile: Unlikely to Lead to Unsafe Abortion


University of Chile researcher and WECARE Affiliate, Dr. Elard Koch and colleagues just published a paper  titled “Women’s Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths:  a Natural Experiment in Chile from 1957 to 2007” in the peer-reviewed journal PLos One.
The researchers assessed variables related to maternal mortality reduction in Chile over the last 50 years, focusing on the implementation of historical policies. The following laws were considered when interpreting trends reflected in the time series analyses conducted: 1) free and mandatory education to a minimum of eight years (1965); 2) an extensive prenatal primary care program with a family planning component (1964-67); 3) therapeutic abortion made illegal (1989). The researchers also tested the modifying effect of women’s education level on other variables known to be associated with mortality rates.  
Dr. Koch and colleagues reported the highest mortality rate across the study period was observed in 1961 (47.9 per 100,000 women of reproductive age), and the lowest was observed in 2003 (.72 per 100,000 women). After abortion prohibition, maternal mortality decreased from 41.3 to 12.7 per 100,000 live births ―a decrease of 69.2% in just  14 years. The study clearly demonstrated that contrary to a frequently voiced (yet never empirically substantiated) claim by researchers and policymakers, illegal abortion did not result in increased maternal deaths due to clandestine abortions.
Factors likely implicated in the reduced mortality rates and noted by the researchers included the following:  1) an increase in the educational level of women; 2) nutrition for pregnant women and their children in the primary care network and schools; 3) universal access to improved maternal health facilities; 4) changes in women’s reproductive behavior enabling them to control their own fertility; and 5) improvements in the sanitary system ―i.e. clean water supply and sanitary sewer access.
Illegal abortion is often equated with unsafe abortion. However, the study by Koch and colleagues challenges this assumption. The clandestine abortions taking place in Chile are apparently low-risk otherwise increased rates of death among women of childbearing age would have been evidenced.